When an individual is injured and is no longer able to work due to a disability, Social Security disability payments may be available to provide them with an income on which to live. Many people believe that they will not be denied these payments, known as Social Security disability insurance (SSDI). However, there are many reasons why an individual may be barred from receiving SSDI.

 A Social Security disability lawyer assists individuals with all aspects of their Social Security claims. While it is always best to have an attorney from the beginning of the claims process, an attorney can assist an applicant at any time.

This is especially true if an individual’s claim has been denied. A lawyer will be familiar with the Social Security application and appeals process and will be able to best present a case for disability. These cases often require adherence to specific rules and regulations as well as the ability to analyze and present complex and substantial medical evidence.

What Disabilities Qualify for SSDI?

There is a range of disabilities that may qualify an individual to receive SSDI. The Social Security Administration (SSA) will examine four areas to determine if an individual’s disability qualifies:

  • The impact of the disability on the individual’s ability to earn an income. If the individual is unable to earn enough income and/or can no longer work due to the disability, they may qualify for SSDI;
  • The severity of the disability as it relates to basic work functions. The disability must be considered permanent, which means it is not a temporary condition. It must be so severe that the individual cannot perform basic work-related tasks;
  • Medical documentation of the disabling condition. There are some conditions that automatically qualify for SSDI income without a showing of other evidence. If the individual’s disability does not fall into that category, they must provide substantial medical documentation from their doctor or other treating medical professionals; and
  • A work analysis. The SSA will determine whether or not the individual is capable of performing the same kind of work and/or profession they engaged in prior to the disability occurring. If the individual is unable, the SSA will then determine whether or not they could perform a new job given their age, education and work experience.

Can I be Denied SSDI for Making Too Much Money?

Yes, an individual can be denied SSDI for making too much income. This is one of the main reasons many individuals are denied SSDI benefits. The Social Security Administration (SSA) sets a maximum income an individual can receive through their substantial gainful activity, or SGA. This amount is considered when an individual is applying for benefits. 

The SGA limit in 2020 was $1,260 per month for an individual who is not blind and $2,110 per month for an individual who is blind. The majority of individuals are denied because they exceed these limitations.

Can I Be Denied Benefits Because of My Work History or Injury?

Yes, an individual’s application may be denied because of their work history and/or injury. In some cases, an individual’s application will be denied because they have not worked long enough. 

Can a Criminal Conviction Impact My Eligibility for Benefits?

In some cases, an individual may be denied benefits if they were convicted of a crime which is connected to their becoming disabled. They may also be denied if their disability occurred when they were incarcerated. For example, if the individual was injured while committing a felony, their benefits would be denied.

What are the Other Reasons Why I Can be Denied Disability Benefits?

Other reasons why an individual may be denied disability benefits include:

  • The SSA cannot locate the individual because their primary address is no longer valid;
  • There is a lack of cooperation on the claimant’s part;
  • The claimant did not and/or does not follow the prescribed therapy;
  • The disability claimed is for an alcohol and/or drug addiction, although a medical consultant would have to make that determination; and/or
  • The claimant has committed Social Security fraud.

What Happens if My SSDI Claim is Denied?

It is very common for SSDI claims to be denied. It is important not to get discouraged and to hire an attorney for help with an appeal. When an individual receives a denial, it will include a review of their disability and information on the appeal process. There are generally four steps to contesting a denial of benefits. These include:

  • Making a written request for reconsideration;
  • A hearing before an Administrative Law Judge (ALJ);
  • Appealing to the Appeals Council; and
  • Filing a lawsuit against the SSA in federal court. 

Most states require a written request for reconsideration. After the request is made, the SSA will review the claim. The individuals responsible for denying the claim do not participate in the review. The claim will be reviewed by a medical consultant and an examiner. A few claims at this stage may get overturned and the person will begin to receive benefits. However, most will be denied again at this stage. If denied at reconsideration, you should receive another written notice of the denial and next steps to appeal.

The second phase is a hearing before an ALJ. An ALJ is an attorney who holds a hearing in which the applicant must appear and have their claim heard. The ALJ determines whether the denial should stand or should be overturned. If the denial is overturned, the applicant may begin receiving benefits. Approximately half of the applicants who appear before and ALJ will receive benefits following a hearing.

The third phase is appealing to the Appeals Council. If the applicant’s claim is denied following a hearing with an ALJ, they may appeal to the council. It is important to note, however, that the council is not required to hear a case. They may hear a case if they believe the ALJ committed an error and/or wrongdoing. Having a case heard by the council is difficult. Winning a case before the counsel is unlikely.

The last option for appeal is to file a lawsuit against the SSA in federal court. This option is only available after completing the first three options. A lawsuit is a time consuming and expensive process. There are, however, a few cases that may be remanded to an ALJ for reconsideration as a result of a lawsuit.

Can a Lawyer Help Me Challenge the Denial of My Request for Benefits?

Yes, an experienced government lawyer can assist you if your Social Security disability claim has been denied. If an individual’s appeal has been denied, they are entitled to an appeal. A lawyer will be able to review your case, review the reason for denial, and assist you in appealing the denial. 

It is essential to have an attorney representing you during any of the appeals in order to have the best chance at securing benefits. There are deadlines that must be followed in each appeal process and an attorney will be familiar with these. This is extremely important because if you fail to follow any appeal requirements, your claim will be denied and you may be barred from seeking an appeal. The help of an attorney may be the difference between an unsuccessful and a successful appeal.